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FREMOUW ENVIRONMENTAL SE RVICE S; INC, <br /> Send Payment to: Phone: 800-559-3274 EPA ID#CAR000171017 CSLB A-Eng#1022665 <br /> 6940 Tremont Road Phone: 707-448-3700 U.S.D.O.T.#1484667 Small Business#56427 INVOICE # (�10 <br /> 9 4i Dixon,CA 95620 Fax: 707-448-3499 D.T.S.C.#3544 , r", ; s <br /> www.fremouwenvironmental.com CA#274461 Date '+- <br /> SITE ADDRESS BILLING/MAILINGADDDAIS3 <br /> CustomerR7i n� )���ai Yf q Pr�1i w�Y <br /> yyo t— <br /> AT TN Met Payab <br /> le <br /> •� 0 3 <br /> ; . s 1 Ave <br /> ,v <br /> d, CA 9!524401 <br /> E.P.A.# r�_ - 1 , a; _ Phone <br /> Additional Contacts: #X1),741� G ��{ 615—E-412. <br /> PAYMENT TERMS: NET 15 <br /> S!U, 6! ita, F OR16") 9WB2221 <br /> PRODLI -1ERVICE INFORMATION/PROPER SHIPPING DESCRIPTION/1311.1 OF LADING <br /> WASTE <br /> 7 a 14 • 21 • 30 • 45 ® 60 • 90 • 180 • 365 W/CCODE TIT <br /> MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> _ <br /> °t) i y: PPM <br /> ' �. -.�-.1� -"t�'.aK �k �`.o� .i i.-... .. .t�. i�a4 ��R! , •S ts�t.,'SM,: r.,.. 7� - . �.S Ta:�� "`rr+ <br /> " ":i:`,34` Y. .�i{r.lr,. nr; .` • it - ,,A 22 7A;i;hs .g.�i.. t v: 4.».`].�')�` <br /> f <br /> '6 ,S 'j! ,E11 <br /> l <br /> e�� l <br /> SERVICES K�EOUEVED 3Y TAX <br /> Acce t P.O.#t TOTAL CHARGES: ! '` <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,maned,and <br /> iabeled,and are in all respects in proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator,I certify that I <br /> have a program in place to reduce the volume and toxicity of waste generated ie the dagree I have determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage,or disposal currently available to ma which minimized the present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made <br /> o good faith effort to minimrse mywaste generation and select the best wasre manegemant method that is available to me and that I can afford.All used oil from the generator listed above <br /> will be transported only to a facility permitted by the State of Califomlo To produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the <br /> management of used oil.All relevant information regarding known or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable costs and attorney <br /> fees incurted in the eollecTlon of this obit anon, Venue for u oses of this abli anon shall be in Solana county. I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial AgriCuilture Government Marine I Other Industrial Lubricating <br /> Oil ori <br /> al <br /> f ,1 <br /> r a-� <br /> Punt Name Generators Signature Drivel t Signature <br /> I hereby certify that I have read and have the authoritgr to bind 4he above listgil generator to the terms on the reverse side of this form. <br /> F101-Rev 08/18 State Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />